Vasculitis   

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

In your experience, are there specific disease manifestations in which HLAB51 is particularly helpful?

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

Would you suggest switching to a viral vector vaccine, such as J&J?

How does this vary from continued disease monitoring?

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

Thoughts on sarilumab vs methotrexate, or just treat with steroids alone

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Would you change rituximab maintenance dose or schedule?

Specifically, do you reach for Rituximab or cyclophosphamide?

ADVOCATE trial

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

In the ADVOCATE trial, patients were not re-dosed with rituximab.

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

How would you label such a patient?  Would you treat differently if they have poor functional status?

 If you use both, how do you decide which to use for a particular patient?